Thursday, November 19, 2009

Mammogram Controversy

Not surprisingly, the recent statement by the US Preventive Services Task Force that women may not benefit form mammograms until age 50, and then recommending that they be done every other year, has been politicized. This is unfortunate; women are left confused and fearful.

I agree with the task force. Keep in mind that it still recommends that women under 50 be screened on an individual basis, if their special circumstances warrant it. So, why the fuss? Follow the money. Those opposed to any Health Care reform are screaming “rationing”, arguing that more of it would come along with reform. Yes, there would be more rationing; but that is exactly what we need, given the carefree spending health care corporations have instituted for themselves, not for the public.

What we need is clearheaded thinking to analyze the problems we have had on cancer screening for a long time. Many feel we have been doing more harm than good by early screening. Again, don’t have a cow: wait to read the whole article so that you may see that women at risk will continue to be screened as before.

Rather than give you my opinion on screening in general, read what I have copied form recent articles on the subject:

“Rethinking Screening for Breast Cancer and Prostate Cancer”,

“After 20 years of screening for breast and prostate cancer, several observations can be made. First, the incidence of these cancers increased after the introduction of screening but has never returned to prescreening levels. Second, the increase in the relative fraction of early stage cancers has increased. Third, the incidence of regional cancers has not decreased at a commensurate rate. One possible explanation is that screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality. To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered."

Translation: screening early may be a mistake. A significant number of cancers lie dormant and we die of something else. An aggressive cancer will kill us, anyhow; so, why worry for more years, having detected the cancer early?

“Contribution of Clinical Breast Examination to Breast Cancer Screening”, Breast cancer detection rates and sensitivity were higher, but so were false-positive rates, among mammography centers that offered clinical breast examination in addition to mammography,

"Overall, we found higher breast cancer detection rates and sensitivities for [clinical breast examination] referral than those previously found in other community-based studies, which suggests that the accuracy of [clinical breast examination] can be improved in screening programs that offer high-quality [clinical breast examinations] by specially trained nurses," the authors write. However, they note, the benefits of adding clinical breast examination must be weighed against potential risks and costs due to false-positive results and the anxiety associated with additional evaluations… For a theoretical population of 10,000 women between the ages of 50 and 69 years, the addition of clinical breast examination would lead to the detection of breast cancer in only four women whose cancer would be missed by mammography. However, adding clinical breast examination would also lead to false-positive results for an additional 219 women, the editorialists point out.”

“What is Wrong with Cancer Tests”,

Many experts feel that early detection of breast cancer, prostate cancer may not do any good. “Tests may be picking up small cancers that would never have caused any symptoms…Once they are diagnosed, almost everybody gets treated-and we know that treatment can cause harm.”

• “Screening’s power to cut risk of dying has been wildly overinflated…By the time cancer is big enough to be seen on a mammogram or other test, it’s already sent seeds to other parts of the body.”
• Detecting small cancers may not do any good. In Denmark a study showed that 39% of middle aged women who died of other causes had breast cancer at autopsy.
• 60% of men at age 60 have undetected prostate cancer; yet only 3% of deaths are due to this cancer
• Only the pap smear has shown a decreased in the risk of death
• Inflated numbers. For instance, colon cancer mortality drops by 60% with colonoscopies. But, mortality is really reduced from 2.3% down to 0.9%. “A benefit, yes, but not necessarily big enough to outweigh all other considerations.” If ½ of those people advised to have a colonoscopy got it done, it would cost more than $110 million dollars/year
• Better tests in the pipeline:
Oncotype DX test measures the activity of 21 genes in tumor cells to calculate the likelihood of the cancer reoccurring in 10 years.
ERG and PCA3 genes: if they are inactive in prostate cancer cells, aggressive therapy could be avoided.
• Screening may be right for you if:
You have a family history, you have a risky mutation, like BRCA 1&2 for breast cancer, you have already had cancer
• Think twice about screening if:
You have another serious illness (it may do you in before the cancer)
You are under 50 or over 70, you are significantly afraid of being harmed by treatment you don’t need
• Other ways you may be overtreated:
CTs involve a lot of radiation
MRIs for back pain are unnecessary
Back Surgery, Knee surgeries
Angioplasties or stents add no survival value over drugs and lifestyle changes, unless you’re in the middle, or aftermath of a heart attack.

Read the book “The Secret History of the War on Cancer” by Dr Davis if you want to understand why we are in disarray when it comes to cancer. We have known for decades that cancers are mutations of our DNA caused by toxins in the environment, poor nutrition and stress. But, we have not concentrated our efforts on these parameters; rather, we focus on chemotherapy, radiation, surgery and expensive screening for cancers that are already there. Why? Follow the money.

The book “Life’s Delicate Balance: The Causes and Prevention of Breast Cancer” was written in 2000 by Dr. Sherman, an Internal Medicine and Toxicology specialist, former EPA board member. She is currently teaching in the Department of Sociology at Western Michigan University on causes of illnesses in workers. She feels that the causes of breast cancer are endocrine active chemicals, pesticides, plastics, and radiation. She does not pull any punches:

“Why is our well funded National Cancer Institute not devoted its efforts to prevention of breast cancer? Has breast cancer, like so many aspects of our culture just another business opportunity? There is a massing, in a few hands, of control of production, distribution and use of pharmaceutical drugs and appliances; control of the sale and use of medical and laboratory tests; the consolidation and control of hospitals, nursing homes and home care providers. We are no longer people who become sick. We have become market. Is it any wonder that prevention receives so little attention? Cancer is a big and successful business! Reflecting on the purpose of the corporation to sell products and services and maximize profits, it becomes apparent that prevention cannot be in the interest of the bottom line. What a sad and bitter realization”.

The 2009 Nobel Prize in Medicine was awarded to researchers who discovered that the longer the tail of our chromosomes(telomere), the longer we live and the less cancers and chronic diseases we have. Well, guess what makes you telomere longer…. antioxidants, good nutrition. It turns out that good food like green tea, curcumin, cruciferous veggies, etc., decrease the risk of cancer by 2/3. Why was this fact not shouted on the 10 o’clock news?

Wisdom of the Ancients

Modern technology has made our lives much easier in many respects. All fields of human endeavor have dramatically benefited from modern scientific miracles. Medicine is no different. Looking back on history one may be tempted to assume that former lifestyles and technologies where “backwards”, or “primitive”. While this would be true in many instances, such conclusion would deprive one of considerable wisdom that may be applicable even today in our technology-driven society.

The wisdom of the ancients, in the form of fables, mythology and legends, is redolent with advice we would do well to heed today. In my opinion, the state of our society with its multiple social, political and economic problems may well be a sign that our technology has not been enough to avoid said maladies.

The tug of war between technology and natural things, or Mother Nature, has raged from the dawn of mankind.

“Vulcan (the God of technology/science) raped Minerva (Gaia/Mother Earth), the consequence of which was the birth of Ericthonius, whose body from the middle upwards was comely and well proportioned, but his thighs and legs small, shrank and deformed like an eel. Conscious of this defect, he became an inventor of chariots, so as to show the graceful, but conceal the deformed part of his body”.

The same tension between opposites has been symbolized by every society in different ways. For example, the ancient pre-Christian sign of the cross, which symbolizes both as above so below, also represents the resolution of the tension between both extremes; in fact, the ancient auroboros, or the snake eating its own tail also means at-one-ment. Think of the Yin-Yang, or Plato and Aristotle pointing up towards the heavens and down towards Earth while they argue about whose viewpoint is correct.

I do not wish to contradict anyone who would take the side of science 100%, or for that matter, doctors who feel our Health Care system is the best in the world. They do have a point. I only wish to suggest that one may then be watching Ericthonius riding by on his chariot and only seeing him from the waist up. And he is beautiful.

Let’s do an exam below Ericthomius’ waist:

1. Technology has brought on unsustainable industries that cannot continue without severely compromising our very lives on planet Earth.

2. The pharmaceutical industry, which began by using products from Mother Earth to treat people (herbs, micro and macro nutrients composed 80% of pharmaceutical products until 1990; now it’s 50%) is now encouraging the indiscriminate use of pharmaceuticals for many conditions that are, for the most part, benign issues. Practically all problems are addressed with pharmaceuticals, instead of focusing on the underlying factors (nutrition, stress and toxic environments) that lead to diseases. Polypharmacy, side effects and exorbitant costs are among several other problems we may see, while chronic care is not managed optimally.

3. Medicine often relies on expensive technology and invasive surgery to replace good judgment, and communication with patients. “In the current environment the balance has tipped toward market exchanges at the expense of medicine’s communal dimension”. Defensive medicine adds fuel to the flames. Disturbing reports continue to emerge that the practice of medicine is in many cases driven by expensive technology to maximize profits for those involved. “The role of the doctor is diminished to one of a competent technician who is interchangeable with any other with similar training… the same is applied to patients… they become interchangeable units of health need”.

4. The internet has dumbed down our society. Doctors are not immune. While surfing the net for information, very few are compelled to dive under for depth. Our children’s writing and comprehending skills are so deteriorated that most corporations have remedial English courses for new hires. The story of Ulysses comes to mind. He was tempted by the song of the sirens promising unbounded knowledge. He knew he would go mad if he yielded to the false promise of vast information with no wisdom, balance or integration. I am afraid that we, doctors are not immune to the sirens’ music.

5. Medicine and our society as a whole have over-emphasized the male aspect of our nature in favor of a more competitive, logical approach, while relegating the equally important feminine side of our nature. Cooperation, communication and feelings are not favorably received in corporate circles. I am afraid that often the same attitudes are found in medicine. We denigrate intuition in favor of logic, instead of marrying the two. We prefer aggressive interventions rather than spending time helping our patients change their lifestyles. While there is a place for acute medicine, the same “masculine” approach to chronic problems is not the answer.

“Deeply concerned about the dehumanization of health care... emotions of knowing intuitively that the way medicine is now taught and practiced is simply wrong, that the humane is being supplanted by unfeeling science and uncaring economics”.

Practically all facets of human endeavor seem to be affected by the rape of Nature. Think of the ills of industrial agriculture, environmentally unsustainable energy production, cities valued above small towns (rural medicine), etc, etc. A more comprehensive view of our society is likely to yield many other examples of Ericthnonius at work, unless you are inclined to think that technology is King. My point is the King needs a Queen.

Monday, November 9, 2009

Are You at Higher Risk for the Flu?

Yes, if you are insulin resistant and/or overweight. So says the JAMA November 4th2009 (“Factors Associated with Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California,” JAMA 2009;302:1896).

But, this is nothing new. Dr. Otto Warburg won the Nobel Prize in Medicine in 1931 by demonstrating that our immune system is less than optimal when our blood sugar levels are elevated, which is the case in some insulin resistance and obese people.

Read my other blogs on the flu.

While most patients are not going to change their diets to decrease their risk of doing poorly with the flu, I would think that some may listen, given the fear that drives them to stand for hours outside some clinic to get the vaccine. I say we publicize these ideas and let people decide.

The bottom line, as always: “it is not the bug, it’s the terrain.”

Docs on Coke

The Deseret News reported November 5th 2009 that the American Academy of Family Physicians formed an alliance with Coca-Cola, ostensibly to advise the public about soft drinks and health. Coca-Cola will give the Academy hundreds of thousands of dollars on the deal.

This is sick. Many doctors are quitting the Academy over this.

If the public needs advice on soft drinks I will do it for free: DON’T DRINK LIQUID CANDY AT ALL!

If you want to study the evidence against soft drinks send me your Email and I will attach the references I have found over the years about the health problems we see with soft drinks.

This is a glaring example of what is wrong with our Health Care system: it has become a business, despite the evidence and the history that health care does not behave like a business. While we all need to make a living, I believe that the system itself should be not-for-profit. Which leads, like everything else, to health care reform; it won’t do a bit of good to haggle over how to finance the present dysfunctional system, unless we put prevention and wellness in front where it belongs.

“I Know My Thyroid is Not Working”

I hear this from a lot from a significant number of patients who feel practically all their symptoms (fatigue, hair falling out being the most common) are due to their thyroid, despite normal serum levels. They frequently add that they have been told or they read on the internet that it is common to have thyroid dysfunction that does not show up in the testing.

Chances are you have also contemplated this dilemma. Assuming you are reading this because you respect my opinion, I will pull no punches in telling you what I believe is going on. If you don’t respect my opinion, then go find a quack down the street who will happily prescribe thyroid for you.

1. If we believe that blood levels are inaccurate, then, we must put EVERYONE on thyroid, since just about all patients have symptoms that could be attributed to low thyroid. By the way, most fatigue is from nutritional issues, stress and lack of sleep. Most hair loss is associated with deficiencies in intestinal absorption of nutrients, and stress.

2. Disreputable practitioners thrive on prescribing thyroid; their patients love them, because they “listen” and because the stimulant effects of thyroid are welcome by those who are comfortable with such an overdone pharmaceutical approach. But, within months of using thyroid that is not needed, these patients begin to feel the overstimulation: no problem! Your friendly practitioner will prescribe valium, xanax and sleeping pills for you. The myth that blood levels are not accurate is, in my opinion, perpetuated by these practitioners. It is true that even a broken clock will tell time correctly twice a day; no doubt there are patients whose tests are not accurate. But, they are rather the exception, not the rule. These patients deserve a complete hormonal work up, including insulin resistance and pituitary assessment, not “a trial of thyroid Rx.”

3. There are over 500 chemicals in the environment, in addition to background atomic fallout from Nevada’s nuclear testing legacy. No doubt they contribute to the strain that our thyroids are under. Add poor diets, hyperinsulinemia and adrenal stress and that makes the Dx of hypothyroidism top the list of problems we have. This should give us pause and make us more conservative in reaching for the prescription pad, instead of handing the hormone out to anyone who asks for it.

4. If you end up needing treatment:
Levothyroxine is very good. I am taking it myself. It may be taken once a week. AND, it is quite natural, as much as desiccated pig (Armour) thyroid is. Since the latter comes form pigs it is not quite the same as human thyroid (if you start oinking while on it you now know why). Yes, levothyroxine is just as natural. Even though it was made in the laboratory, it has been structured to virtually mimic our own native thyroid hormone. Think of insulin: science has advanced to such a point that these hormones are virtually “natural.” Think also of H2O. We make it in the lab to be equal to what we get from clouds because we know its structure.

5. Most people do not need T3 when they get T4. The body converts T4 into T3 at the correct rate. Each organ does it according to its own needs. The skin needs a whole lot less than the heart and brain. Other organs need different amounts somewhere in between the organs mentioned above. A blood level will determine if conversion from T4 to T3 is taking place. To take Armour just to give T3 is not a good approach. Armour has a fixed amount of T3, which is much higher than the levels our body needs in relation to T4: all organs then end up on the same excessive amount of T3, which may create problems, particularly with the heart (it happened to me).

6. Armour is reported to be going off the market due to low demand (docs don’t like it because of the above issues). So, my advise to you is to accept your docs’ prescription of levothyroxine, if you really need it.